Abstract Country-specific data on NCDs in Africa are scarce and most of the available data are based on estimations. This is true for Zambia, making it difficult to assess the burden of NCDs and the capacity of the health system to respond to the burden of NCDs. There are clear gaps in the evidence of successful implementation of NCD interventions within the primary health care setting in Sub-Saharan Africa, despite WHO putting forward recommendations through the WHO Essential Non communicable Disease Interventions (WHO PEN package) to tackle NCDs. We propose a mixed-methods approach to assess health systems capacity to provide NCD related services by adopting and adapting a WHO recommended NCD tool in the Zambian context. This preliminary work will inform the design of a comprehensive long-term study to be supported through an R01 mechanism, which will adopt the WHO PEN package to improve NCD services in primary care within Zambia. To accomplish these aims we have assembled a strong multidisciplinary team representing Vanderbilt University and the University of Zambia. Completion of this study and the follow-up trial will not only benefit the health system in Zambia but will also provide evidence on how to re- orient health systems in Sub-Saharan Africa, to address the growing NCD burden. To our knowledge this will be the first study to address health systems? capacity to respond to the growing threat of NCD in Zambia.